Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Diagnosis

Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

Online
ISSN
2194-802X
See all formats and pricing
More options …

Understanding the “philosophy” of laboratory hemostasis

Giuseppe LippiORCID iD: https://orcid.org/0000-0001-9523-9054 / Dorothy Adcock / Emmanuel J. Favaloro
  • Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-12-18 | DOI: https://doi.org/10.1515/dx-2018-0099

Abstract

Unlike many other areas of laboratory medicine, laboratory hemostasis has some peculiarities, which makes it one of the most complex diagnostic domains in clinical medicine. The inherent complexity of the hemostasis process, the components of which have not yet been thoroughly unravelled, is mirrored by a large number of hemostasis disturbances, which can involve single or multiple components. Although laboratory diagnostics represents an unavoidable part of the diagnostic reasoning in patients with bleeding or thrombotic disorders, the basic concept beneath the assumption that in many human pathologies, one single test may be sufficient for the diagnosis, does not hold true in hemostasis. There are in fact many aspects that would lead us to conclude that laboratory hemostasis can be considered a very challenging arena for many clinicians and perhaps also for some laboratory professionals. The most challenging aspects typically include the following concepts; that hemostasis is an intricate and multifaceted process, that more than one test is typically needed to achieve a final diagnosis, that results of screening tests depend on many biological factors and do not allow making a final diagnosis, that harmonization of techniques is still an unmet target, and that the calculations used vary widely among laboratories. This article is hence aimed at discussing many of these aspects, with the hope of presenting a useful contribution to better understand the “philosophy” of laboratory hemostasis.

Keywords: coagulation; diagnosis; harmonization; hemostasis; laboratory

References

  • 1.

    Favaloro EJ, Lippi G. Laboratory reporting of hemostasis assays: the final post-analytical opportunity to reduce errors of clinical diagnosis in hemostasis? Clin Chem Lab Med 2010;48:309–21.Web of SciencePubMedGoogle Scholar

  • 2.

    Lippi G, Favaloro EJ. Laboratory hemostasis: from biology to the bench. Clin Chem Lab Med 2018;56:1035–45.CrossrefWeb of SciencePubMedGoogle Scholar

  • 3.

    Lippi G, Favaloro EJ. Venous and arterial thromboses: two sides of the same coin? Semin Thromb Hemost 2018;44:239–48.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 4.

    Lippi G, Favaloro EJ. Hemostasis practice: state-of-the-art. J Lab Precis Med 2018;3:67.CrossrefGoogle Scholar

  • 5.

    Bonar RA, Lippi G, Favaloro EJ. Overview of hemostasis and thrombosis and contribution of laboratory testing to diagnosis and management of hemostasis and thrombosis disorders. Methods Mol Biol 2017;1646:3–27.PubMedCrossrefGoogle Scholar

  • 6.

    American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care 2018;41:S13–27.Web of SciencePubMedGoogle Scholar

  • 7.

    Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018;72:2231–64.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 8.

    World Health Organization. Diagnosis of malaria. In: guidelines for the treatment of malaria. 3rd edition. Geneva: World Health Organization; 2015. Available from: https://www.ncbi.nlm.nih.gov/books/NBK294435/. Last accessed: 29 Oct 2018.

  • 9.

    Larsen JB, Hvas AM. Predictive value of whole blood and plasma coagulation tests for intra- and postoperative bleeding risk: a systematic review. Semin Thromb Hemost 2017;43:772–805.CrossrefWeb of ScienceGoogle Scholar

  • 10.

    Danese E, Montagnana M, Lippi G. Factor XII in hemostasis and thrombosis: active player or (innocent) bystander? Semin Thromb Hemost 2016;42:682–8.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 11.

    Pierangeli SS, de Groot PG, Dlott J, Favaloro E, Harris EN, Lakos G, et al. ‘Criteria’ aPL tests: report of a task force and preconference workshop at the 13th International Congress on Antiphospholipid Antibodies, Galveston, Texas, April 2010. Lupus 2011;20:182–90.Web of ScienceCrossrefPubMedGoogle Scholar

  • 12.

    Adcock DM, Favaloro EJ, Lippi G. Critical pre-examination variables in the hemostasis laboratory and their quality indicators. Clin Biochem 2016;49:1315–20.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 13.

    Favaloro EJ, Lippi G. On the complexity of hemostasis and the need for harmonization of test practice. Clin Chem Lab Med 2018;56:1568–74.PubMedWeb of ScienceGoogle Scholar

  • 14.

    Kershaw G. Performance of activated partial thromboplastin time (APTT): determining reagent sensitivity to factor deficiencies, heparin, and lupus anticoagulants. Methods Mol Biol 2017;1646:75–83.PubMedCrossrefGoogle Scholar

  • 15.

    Barriere SL, Goldberg R, Jac JW, Higgins DL, Macy PA, Adcock DM. Effects of telavancin on coagulation test results. Int J Clin Pract 2011;65:784–9.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 16.

    Fritsma GA, Dembitzer FR, Randhawa A, Marques MB, Van Cott EM, Adcock-Funk D, et al. Recommendations for appropriate activated partial thromboplastin time reagent selection and utilization. Am J Clin Pathol 2012;137:904–8.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 17.

    Bethel M, Adcock DM, Zalevsky J, Young M, Fagrell B. Polyethylene glycol-induced prolongation of aPTT in two biopharmaceuticals. Int J Lab Hematol 2007;29:69.Google Scholar

  • 18.

    Bonar R, Favaloro EJ. Explaining and reducing the variation in inter-laboratory reported values for International Normalised Ratio. Thromb Res 2017;150:22–9.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 19.

    Favaloro EJ. Optimizing the verification of mean normal prothrombin time (MNPT) and international sensitivity index (ISI) for accurate conversion of prothrombin time (PT) to international normalized ratio (INR). Methods Mol Biol 2017;1646:59–74.PubMedCrossrefGoogle Scholar

  • 20.

    Clinical and Laboratory Standards Institute. Procedures for validation of INR and local calibration of PT/INR systems, 1st edition. Approved Guideline. Clinical and Laboratory Standards Institute, Wayne, Pennsylvania, USA, CLSI document H54-A; 2005.Google Scholar

  • 21.

    Söderström AC, Nybo M, Nielsen C, Vinholt PJ. The effect of centrifugation speed and time on pre-analytical platelet activation. Clin Chem Lab Med 2016;54:1913–20.Web of SciencePubMedGoogle Scholar

  • 22.

    Favaloro EJ, Lippi G. Reference ranges in hemostasis testing: necessary but imperfect. J Lab Precis Med 2017;2:18.CrossrefGoogle Scholar

  • 23.

    Favaloro EJ, Pasalic L, Curnow J, Lippi G. Laboratory monitoring or measurement of direct oral anticoagulants (DOACs): advantages, limitations and future challenges. Curr Drug Metab 2017;18:598–608.PubMedWeb of ScienceGoogle Scholar

About the article

Corresponding author: Prof. Giuseppe Lippi, Section of Clinical Biochemistry, University of Verona, P.le LA Scuro 10, Verona 37134, Italy


Received: 2018-11-04

Accepted: 2018-11-30

Published Online: 2018-12-18


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Diagnosis, 20180099, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0099.

Export Citation

©2018 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in